ABSTRACT
With the outbreak of the Coronavirus Disease-2019 (COVID-19) pandemic, it is not uncommon to see patients who present with respiratory symptoms secondary to an abdominal pathology, being suspected of having COVID-19. Here, authors report a case of an elderly female who presented with recent-onset dyspnoea, shortness of breath, pain abdomen and non passage of flatus and stools. Examination revealed that the patient had tachycardia, tachypnoea, and dyspnoea with an oxygen saturation (SpO(2)) of 92%. Her abdomen was distended, non tender with no free fluid detected. All the hernial orifices were free. Computed Tomography (CT) scan revealed a left diaphragmatic hernia and a left-sided obturator hernia with obstructed ileal segment. However, intraoperatively a Type IV hiatus hernia was discovered, where the Gastrooesophageal (GE) junction, stomach, colon, and omentum were the contents. This case highlights an unusual clinical presentation of a rare cause of intestinal obstruction and its management during the COVID-19 pandemic. Obstructed obturator hernia is associated with high morbidity and mortality.
ABSTRACT
Background: The declining trend of COVID-19 infection in India has made healthcare personnel (HCP) and general public lenient about personal-protective-measures. Serosurveys to estimate the prevalence of SARS-CoV2 IgG antibodies, particularly in high-risk-zones like hospitals can give the real scenario and risk-factors can help prioritise the target population for urgent, effective vacccination. Methods: 1470 consecutive HCP from 4 tertiary-care-hospitals in Kolkata filled a questionnaire and were tested for serum SARS-CoV2-IgG by Enzyme-linked Immunosorbent Assay (ELISA). The prevalence of SARS-CoV2-IgG among asymptomatic HCPs was studied and the work environment, clinical comorbidities, personal habits and protective measures and pharmacologic prophylaxes were compared between those with and without SARS-CoV2-IgG. Parameters of asymptomatic seroconverters were also compared to those with personal history of COVID-19-Infection. Logistic regression was done to identify independent risk-factors. Results: Prevalence of asymptomatic seroconversion was 15.8%. Asymptomatic seroconverters (n=208) were mostly working in mixed hospitals (having both COVID-19 and non-COVID-19 wards, 57.7%), were non-doctors by profession (nurses-25.1%, others–51.4%). Among asymptomatic HCP, indepedendent positive risk factors for SARS-CoV2 IgG-positivity were Diabetes Mellitus (DM) and multiple comorbidities (pboth <0.001) and prophylactic use of Hydroxychloroquine and Famotidine (pboth < 0.03). However, for symptomatic COVID-19 infection, working in COVID-19 dedicated hospitals, and personal h/o COPD were positive risk-factors and Ivermectin prophylaxis a negative risk-factor (pall < 0.03). Conclusion:In our study conducted i n the i mmedi ate pre-i mmuni sati on peri od, rate of asymptomati c seroconversion among HCPs is too low to presume herd immunity. Those working in mixed hospitals and DM, multiple comorbidities are at particularly high risk.